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410 Termination STATEMENT OF Ofl(3ANIZATION Statement of n. ; ,t ,,..ruan.za.o. '~. or print In Ink ..o,.,..t co.,.,,... ~ l~ 0 ;'TY E - ~'~°~'~~o~ 410 .o~y~,nn,df-t 0~ L~U)...,,d~. u~,.o..=,~:. JUL 24 ~ ~ I ; ~· ~ ~ ~; ~ ~ Ct PERTINO CI~ CLEF ( D~e~fl~,.A~; D~~ ~,.d~; ~T~ m~) 1. Commi~ee Info~ation 2. Treasurer and ~her PHncipal ~ce~ ~E~~E ~ ~ ~ ST~ET ~O~ ~ P.O. ~ ~ ffi ~ ~E ~~E C~ ~ ~ ~E ~ ~WE ~E ~ ~IST~ ~~ IF ~ 0~ F~I~~ ~ ~ ~ ~P ~E ~ ~~E 3. Verification. I have used all reasonable diligence In pmpmlng this statement and to the best of my knowledge the informaUon contained herein b true and complete. I certify under penalty of perjur/under the I-- of Ule Statll of CaliFomla thBt the foregoing b tme end ~~..~~Executed on 7///~//~~-''' 'By co · FPPC Form 410 FPPC Toll-Frae Helpflne: 86E/ASK-FPPC tatement of Organization STATEMENT OF ORC-.-.-.-.-.-.-.-.-.~IZAnON Recipient Committee ~,IF~ 41 0 FORM INSTRUCTIONS ON REVERSE I:~ COMMITTEE NAME I.D. NUMBER 4. Type of Committ®a Complete the applicable seotion~. · Li~t the n~me of each conlrolling officeholder, candidate, or stal~ measure proponent. If candidate or offce~older controlled, al~o list the elective office ~ou~ht or held, and district number, if any, and the year of the election. · List the poll§cai party with which each officeholder or cendid~te is affiliated or check "non-partisan." · If this committee acts joinlly with another controlled committee, list the name and identification number of the other controlled commit'~e. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE/OFFICEHOLDER/~TATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY [] Non-I~rtir~n [] Non-Partisan · List the financial institulion where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREACOOE/PHONE BANK ACCOUNT NUMBER ADDRE~ CITY STATE ZIP CODE P r m T , ~ r d y F o t m e ( ! Committee Primarilyformedtosupportoropposespeciflccandk:latesormeasuresinaslngleelection. LLstbelow: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE ~OUGHT OR HELD OR MEASURE(S) ~URISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, A~ APPLICABLE) CHECK ONE aUIq~RT OPP0~E FPPC Fora1 4t0 (Jan/01) FPPC Toll-Frae Helpllne: 866/ASK4=PPC Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CAUFORN;A410 FORM INSTRUCTIONS ON REVERSE Plge I COMMITTEE NAME I.D. NUMBER 4. T¥1~ of Commit~e G(?n~:,r,H Puu)os;e Comtmth.,~? Notformedtosupportoropposespeciflccandidat~sormeasumsinasingleelectlon. Checkonlyonebox: [] CITY Comml#ee [] COUNTY Conlmla~e [] STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY SI;OrT,~o~,?(/ Co~Tm/tteE, Li~t additio~l spot. om on ~ -tt~chrn~nt. NAME OF SPONSOR IINDUSTRY GROUP OR AFFILIATION OF SPONSOR I STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Sm¢~ll Contr/hulo¢ Commilt©e [] I ~.__ C~b~and~t~da~ls~mmi~qua~asasmall~ntHbut~m~. ~the~mi~eeq~l~asasmall ~ qu~ ~but~ ~mm~ ~ Jan~ 1, ~1, ~ter 111~1. 5. Te~ination Requimme~ By~gn~ng~e~n~th~sumr~b~nt~mran~r~ate~h~er~pm~nt~t~ta~e~nd~h~n~: · This ~mmi~ee has ma~ to m~i~ ~tdbutions a~ make ex~nditums; · Th~ ~mmi~ d~s not anticipate m~iving ~n~butions or maki~ ex~ndi~ms in ~e fu~m; · This ~mm~ has elimina~ or has no intention or abili~ to discha~e all deb~, ~ns m~ived, and other obligations; · This ~mmiff~ has no su~lus ~nds; and · This ~mmi~e has fil~ all ~mpa~n s~temen~ required by the Politi~l Re~ A~ di~sing all m~ble tmnsa~ions. -- Them am mstd~bns on the dis~sition of su~lus ~mpaign funds held by el~t~ offi~m who am lea~ng ~ce and by def~ted ~ndidates. Refer to Go~m~ ~e Se~n 8~19. -- Addit~nal fili~ obligations will ~ incu~d if, a~r te~inating, the ~mm~ee m~ives or spends any funds, ~ m~iv~ the ~i~ness ~ a I~n, mpa~en~ ~ ~ans ma~ ~ ~hem, or any other m~ip~. FPPC Form 410 (Jan/fl) FPPC Toll.Free Help#ne: 866/ASK-FPPC